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,. LICENSED CONTRACTOR DECLARATION
I r.by affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with. Section 7000) of Division 3. of the Business and
►Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
T � ,
,Da' e :� "•/ `r ignature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals_
Code).
( ) I am exempt under Section , B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 370.0 of the Labor Code, for the
performance of the work for which this permit is issued..
). I have and will maintain workers' compensation insurance, as required by
S6&Ion 3700 of the Labor Code, for the performance of the work. for which this
permit is issued. MY workers' compensation insurance carrier & policy no. are:
Carrier �T.t�'{ F _111 a Policy No. f7'44� � =s'kf
(This section need not be completed if the. permit valuation is for $100.00 or less).
( ). I certify that in the performance of the work for which this permit. is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California; and agree that1f 1, -,should become
subject to thg wor Cers' compensation provisions of Sectiom3700 of the Labor
Code, I al rf jrVfWith•;comply with t o4e provisions. I
fe: � ., A�pPlicant � t'di ' t,,•T....-•c>�
Warning: Failure to secure Workers' Compensation coverage• is unlawful and
shall subject an employer to criminal penalties and civil:fines up to $100,000, in
addition,to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above: information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorlie representatives 'of this. City to enter upon
the above-mentioned property ,{or inspection purposeB.
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,✓Signature (Owner/Agent) 1 ,
at
BUILDING PERMIT PERMIT� 2
DATE VALUATION - 1423.XWAO LOT RAR314 TRACT Ilk, 1f) 7 21
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JOB SITE t,.°�
ADDRESS t�'"ulvg �81F.� 190WV W d f
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?7"704.%Q1
OWNER
CONTRACTOR/DESIGNER/EN INEER
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1-11CA9 0E"1'02PJ, r::` 4a'i°Rf'+C''AN` CORR
I 1!, Q10M, 3-'CKETT
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1,!F P0- T .e,RACK 'CA A 9264..6
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(,'W49)'I•d4-01161 Ca'14 1756
USE OF PERMIT
An pl!7 is
WCLUDE WALU OR C'00pt..., I+'19.- t spailwi.':i.l:m,9D.
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8,3n.06 by 1',
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Ct::'.4 TACT AMOLtNT :.'•moi kI rb.00 LZ
R3"1CiN�'N%.IM. Coll -TI, (V i*_110biF�RJ.'1.{fC.r 0_11
4,,4,-,530.W
i:ONSTRY) L'f ON YE Z? 101 -000,418-000 M1_Y1 1.50 '
PLAN CHECK Flflt' l (5 t ••CffJ€iN4:�9-318 �dtluR Su
MECHANICAL FRE 101.000-421-000 Ei;f�4.A0
ELECIrPiCAL. FEE SI.3.66
1'i. UM11410 FFE 10 1-000-419.000 $641, OR
3TRO3+iO MOTI03+1' IFEL IZES;L? IGi -000.241-000
CMADIVO I`lKS 101.000.4?Z'A-000 '$15.00
flL'Y"frd.OPER l'Mrp,CT n—P s11,Era 110
AIR -1.1, IWN POK1C KIACE$ . Idr01(: V0,000-40-000 $559,33
114M PLAN V CIITHPK,i :
",Ia, :14.90
� Tc3 r. s L PFRIVfff .FEES DU NOW
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RECEIPT
DATEBY
DA . FI D
INSPECT
I
INSPECTION RECORD Q1
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Fomes & Footings _ l-
Ducts
Slab Grade /3—
Return Air
Steel
Combustion.Air
Roof Deck / p
Exhaust Fans
OX to Wrap p/,
F.A.U.
Framing
Compressor
Insulation - L
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath 3
Drywall - Int. Lath
Final
Final "I
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL'. APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Maln Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final 1 O
Utility Notice (Perm)
COMMENTS:lowle/VA11 &It/d�iJ�3 COY—
Certificate of Occupancy
Twf 4 4 QUW'- &
Building & Safety Department
This Cer#igcate is issued pursuant to the requirements- of Section 109 of the California Building
Code, certifying . that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 50-660 EISENHOWER DR. BLDG 28
Use. classification: A3
Occupancy Group: MFD
Type of Construction:V-N
Owner of Building: APARTMENTS AT LA QUINTA VILLAGE LP.
Building Permit No.: 0306-229
Land Use Zone: V -C
Address: 1105 QUAIL STREET
City, ST, ZIP: NEWPORT BEACH CA 92660
By: G.SHOWALTER
Date, 12/16/04
01126/2085 88:44 17603401819 PAGE 21/27
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INSULA TON CE ,�ICATE
This is,10 ON* that ka allon has been WAWW in conformance with the c uffent energy
t regUtadon, Caiiromia Adminisfrotbe Cada, Title 24, WA of California, in ft twlid rig at
LA QUINTA VILLAGE AP QUINTA CA
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TYP TTS MAUNFACTURER: CarCahu d '{'HICKNEW: R-30
TTS MANUFACTURER: CertaMWW THICKNESS: R-13
GENERAL CONTRACTOR: LUCAS GENERAL CONTRACTINo CORP LICENSE # % S
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221817
&J.,wAd A-4 f TITLE: ACCOUNT REPRESENTINE DATEL146(1
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INSULA-110HwGER-GE'VA ■ _4
This IB to vw* that Iremiation hn been Inst" In wftm mw with the current energy
regulation, Calllornia Admin Mrative Code, TM9 24, State of California, in the building located at
LA Qu1NTA wLAsE APARTMENT$JiSLDA JtB' LI4 QUINTA CA
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TYPE: BATTS MAUNFACTURER: Carlainbsed THICMESS. R -W
TYPE: BAITS MAUNFACTURER: CeralnWed THICKNESS; R-13
GENERAL CONTRACTOR LUCAS GENERAL CONTRACTING CORP LICENSE #%S_ -k Tk5
BY.us om
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PARAGON 1;�/HMID BUILDING PRODUCTS A MASCO Company LICENSE # 22151 T
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BY: TITLE: ACCOUNT REPRESENTIVE DATE:.
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